Provider Demographics
NPI:1679125496
Name:JENSEN, COREY (DC)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:JENSEN
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 COUNTY ROAD 519
Mailing Address - Street 2:
Mailing Address - City:BLAIRSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07825-4034
Mailing Address - Country:US
Mailing Address - Phone:908-752-3433
Mailing Address - Fax:
Practice Address - Street 1:100 HOLLISTER RD
Practice Address - Street 2:
Practice Address - City:TETERBORO
Practice Address - State:NJ
Practice Address - Zip Code:07608-1148
Practice Address - Country:US
Practice Address - Phone:201-365-6171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2025-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00763600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ38MC00763600OtherCHIROPRACTIC